First Edition: Jan. 2, 2014

The early morning highlights from the major news organizations, including reports about what to expect of the health law in 2014.

Kaiser Health News: The Health Law Takes Effect: A Consumer's Guide
Kaiser Health News staff writer Mary Agnes Carey reports: "Starting Jan. 1, central provisions of the Affordable Care Act kick in, allowing many uninsured Americans to afford health insurance. But the landmark law still faces heavy opposition from Republicans and from a public that remains skeptical the law can improve health care coverage while lowering its cost. The law has already altered the health care industry and established a number of consumer benefits. It will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors. … Here's a primer on where the law stands now and how it might change" (Carey, 1/1). Read the story.

Kaiser Health News: Insuring Your Health: Despite Health Law's Protections, Many Consumers May Be 'Underinsured'
Kaiser Health News consumer columnist Michelle Andrews writes: "People with chronic conditions will be better protected from crippling medical bills starting in January as the health law's coverage requirements and spending limits take effect. But a recent analysis by Avalere Health found that many may still find themselves 'underinsured,' spending more than 10 percent of their income on medical care, not including premiums, even if they qualify for cost-sharing subsidies on the health insurance marketplaces" (Andrews, 12/31/13). Read the column.

Kaiser Health News: One Texan Weighs Obamacare Options: High Deductible Vs. 'Huge Fear'
KUHF's Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: "Boudreaux, 43, lives just outside of Houston and works as a psychiatric social worker on a freelance basis, with no benefits. This year Boudreaux estimates she spent about $1,500 on medical care, including a trip to the ER for a cut finger. She also takes a few prescription medications and occasionally sees a psychiatrist and a nutritionist. She can’t get insurance through her partner, because her partner’s employer doesn’t offer benefits to same-sex couples. And, Boudreaux has been skipping mammograms and other check-ups for a few years. 'It's worrisome,' she says. 'It's like gambling. Gambling with my health, and it is very frustrating'" (Feibel, 12/26/31). Read the story.

Kaiser Health News: Capsules: Iowa Opens The Doors To Medicaid Coverage, On Its Own Terms; Finding Health Insurance For 71 Cents Per Month
Iowa Public Radio’s Clay Masters reports on Iowa’s version of Medicaid expansion: “When the federal Affordable Care Act called for states to expand Medicaid programs to cover people like Gross, Iowa Republican Gov. Terry Branstad refused. He said he feared the federal government wouldn’t come through on its promise to fund the expansion to include childless adults. Iowa was one of many states that initially refused all or part of the federal funds offered. … Eventually Branstad said ‘yes,’ but only if Iowa could take the money on its own terms. The state legislature, which is evenly split between Republicans and Democrats, came up with an alternative: Federal expansion dollars would pay for managed care policies that poor people would select on the HealthCare.gov site” (Masters, 1/1).

Also on the blog, Mississippi Public Broadcasting’s Jeffrey Hess reports on how the federal health exchange is working for his state’s residents: “If you’re looking for evidence that healthcare.gov, the federal health insurance marketplace, is working much better these days, you might want to ask Arlene Wilson. The 56 year old is a chef with a popular pizza shop in Jackson, Mississippi. Wilson says that “most jobs don’t offer” health insurance. Because “most of us live paycheck to paycheck,” she says she’s been unable to afford insurance for the past eight years. But the health law was designed to help people like Wilson and her co-workers (Hess, 1/2). Check out what else is on the blog.

The New York Times: Consumers Start Using Coverage Under Health Law
Consumers around the country began using coverage provided by the new health care law on Wednesday, the same day that Medicaid expanded to hundreds of thousands of people in about half the states. Many provisions of the 2010 health care law offering new benefits and protections to consumers, including those with pre-existing conditions, also took effect. Hospitals said they were getting ready for an influx of newly insured patients, but many health care providers said the pace was slower than usual because of the New Year’s holiday. In a typical report, Clay Holtzman, a spokesman for Swedish Medical Center in Seattle, said the system’s hospitals were not seeing an immediate surge (Pear and Goodnough, 1/2).

Politico: For Obamacare, It's Finally Showtime
Obamacare just got real. Sure, there were some new rules and benefits over the last few years, but that was just a warmup. Starting today, all of the big pieces of the Affordable Care Act — the biggest domestic achievement of Barack Obama’s presidency and one of the most far-reaching changes in American social policy in decades — go into effect. And Americans will start to see, for better or worse, how the law really works. ... Obamacare supporters and the president and his team can bask for just a moment in the glow of their long-sought goal finally becoming law — but only for a moment. The ACA’s Perils of Pauline debut is going to continue. Here are the obstacles ahead this year (Nather, 1/1).

The Wall Street Journal: Health Law's Uneasy Launch
Nearly four years after President Barack Obama signed his health initiative into law, the Affordable Care Act is officially reshaping America's $2.75 trillion health-care system. A survivor of bare-knuckle political fights, a U.S. Supreme Court challenge and a technologically disastrous rollout, the law now faces a fundamental test: Can its mix of government subsidies and market-based competition extend health insurance to millions of people whose medical conditions, income level or personal choice left them without it? (Weaver, 1/1).

Politico: White House Expects Day 1 Obamacare Snags
The health coverage under Obamacare finally begins New Year’s Day and the Obama administration knows that it may not all go smoothly. More than 2.1 million people have signed up through the state and federal exchanges, and Obama administration officials acknowledged that some of them may not actually have their new health plan finalized Jan. 1, because of all the tech problems that plagued HealthCare.gov during the last three months (Norman, 1/2).

Los Angeles Times: White House Issues New Tip Sheet For Obamacare Consumers
The Obama administration is releasing a new tip sheet for Americans who have signed up for coverage under the president’s healthcare law and is urging consumers to be careful before they start using their new insurance Wednesday. … Since Oct. 1, approximately 2.1 million people have enrolled in a private health plan through new marketplaces created by the Affordable Care Act, the administration announced Tuesday. About an additional 4 million low-income Americans have qualified for Medicaid or the Children's Health Insurance Program (Levey, 12/29/31).

Politico: Key Obamacare Changes Come With The New Year
Coverage begins on Jan. 1 for people who selected plans through new federal and state exchanges before the Dec. 24 deadline. Others have until March 31 to sign up. Many Americans can receive federal subsidies to help pay for insurance. Several million low-income people also qualified for Medicaid, which 26 states are expanding under the health law that President Barack Obama signed nearly four years ago. But there’s a ton of fine print taking effect, too, nitty-gritty details that are critical to making the health law work as intended. Here’s a look at some of the other Obamacare elements taking effect Jan. 1 (Cheney, 12/31/13).

USA Today: Health Care Changes To Watch For 2014
Beyond the law's new requirements, analysts and industry officials say they anticipate a series of related changes to affect health care in 2014, including: Private exchanges. ... Employer mandate. ... Pricing transparency. ... New rules and higher enrollments. ... Electronic records. ... Shrinking networks. ... States will drive change. Medicaid, which is run by the states, will have the most impact on local price structures (Kennedy, 1/1).

The Washington Post: Beneath Health Law's Botched Rollout Is Basic Benefit For Millions Of Americans
Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. ... Peterson is among the millions of uninsured Americans who are benefiting from the Affordable Care Act ... These beneficiaries have not been oblivious to the problems of the new insurance exchanges, ... [Yet] as New Year’s Day approaches, and with it, health insurance, their frustration is trumped by gratitude (Sun and Goldstein, 12/28/13).

The New York Times: Millions Gaining Health Coverage Under Law
The decisively new moment in the effort to overhaul the country’s health care system will test the law’s central premise: that extending coverage to far more Americans will improve the nation’s health and help many avoid crippling medical bills. Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations (Pear and Goodnough, 12/31/13).

The Washington Post: Obamacare’s 2013 Tally: Six Million Signed Up For Coverage
Health and Human Services Secretary Kathleen Sebelius told reporters that 2.1 million have signed up for coverage through Dec. 28. That includes the 1.1 million that the White House had announced this past Sunday, who had enrolled through Dec. 24 on HealthCare.gov. There are also 3.9 million people who have been found eligible for Medicaid (Kliff, 12/31/13).

The Wall Street Journal: Health-Plan Enrollment Surpasses 2.1 Million
Nationwide enrollment in private health plans under the Affordable Care Act has topped 2.1 million, the Obama administration said Tuesday as it prepared to tackle potential new problems when coverage takes effect New Year's Day. The enrollment figure as of Dec. 28, announced by Health and Human Services Secretary Kathleen Sebelius, encompasses the federal health-insurance exchange serving 36 states and those who enrolled through exchanges in the 14 states that are running their own marketplaces. ... Uninsured people have until March 31 to sign up for coverage or run the risk of being required to pay a 2014 penalty (Schatz, 12/31/13).

The Washington Post: With New Year, Medicaid Takes On A Broader Health-Care Role Medicaid embarks on a massive transformation Wednesday — from a safety-net program for the most vulnerable to a broad-based one that finds itself at the front lines of the continuing political and ideological battle over the Affordable Care Act. Already the nation’s largest health-care program, Medicaid is being expanded and reshaped by the law to cover a wider array of people. Among them will be many who consider themselves middle class (Somashekhar and Tumulty,, 12/31/13).

USA Today: Health Law May Hit Midsize Businesses Hardest
The new year will bring tough new health care decisions for many businesses, especially those that are too small to easily absorb new costs and too big to think about dropping coverage, experts say. These midsize businesses, particularly those with 50 to 200 workers, are having the toughest time affording escalating health care costs, says Nancy Taylor, a health care lawyer with Greenberg Traurig (O’Donnell, 12/31/13).

Politico: W.H. Stands By Birth-Control Rule
The Obama administration Wednesday said the Affordable Care Act contraceptive coverage regulations are fair – and they don’t really hurt the Denver-based religious organization that got a temporary New Year’s Eve reprieve from Supreme Court Justice Sonia Sotomayor. “We defer to the Department of Justice on litigation matters, but remain confident that our final rules strike the balance of providing women with free contraceptive coverage while preventing non-profit religious employers with religious objections to contraceptive coverage from having to contract, arrange, pay, or refer for such coverage,” a White House official said (Allen, 1/2).

The New York Times: Health Law Challenge Opens Up New Front
Temporarily blocking enforcement of the part of President Obama’s health care law that requires many employers to provide health insurance coverage for birth control or face penalties, Justice Sonia Sotomayor on Tuesday opened a second front in Supreme Court challenges to the provision. The initial front opened in November, when the justices agreed to hear a pair of cases from for-profit companies challenging that provision. Now Justice Sotomayor has ordered the Obama administration to file a brief by Friday morning responding to a different kind of challenge, this one from groups affiliated with religious organizations. In the meantime, she issued a temporary injunction barring the administration from enforcing the birth control requirement against an order of Colorado nuns, the Little Sisters of the Poor, and related groups (Liptak, 1/1).

Los Angeles Times: Justice Sotomayor Grants Temporary Obamacare Exemption To Nuns
Supreme Court Justice Sonia Sotomayor granted a temporary exemption late Tuesday to a small group of Catholic nuns that shields it from having to comply with a part of President Obama's healthcare law that requires it to provide contraceptive coverage in its insurance plans. She acted on an emergency appeal from lawyers for the group who said the nuns faced "draconian fines" beginning on New Year's Day if they failed to comply with the law widely known as Obamacare (Savage and Reston, 12/31).

The Washington Post: Supreme Court Temporarily Allows Religious Groups Not To Cover Birth Control
The Obama administration faced a fresh challenge to its health-care law just as many of its key provisions took effect Wednesday, after an eleventh-hour Supreme Court ruling temporarily allowed some Catholic groups not to cover birth control in their employee health plans. The requirement that employers cover contraception and related medications and procedures has been one of the most controversial parts of the Affordable Care Act, leading to dozens of lawsuits from groups that say it violates their religious freedom. The Supreme Court will hear arguments on the issue this year (Somashekhar, Barnes and Boorstein, 1/1).

Kaiser Health News on Wednesday tracked additional headlines and coverage of this development (1/1).

The New York Times: Second Official to Leave After Health Site Trouble The No. 2 official at the Centers for Medicare and Medicaid Services, who supervised the troubled rollout of President Obama’s health care law, is retiring, administration officials said Monday. Michelle Snyder oversaw the technology experts who built the HealthCare.gov website. The official, Michelle Snyder, is the agency’s chief operating officer. She is the second administration official to depart since problems at the website, HealthCare.gov, frustrated millions of people trying to buy insurance and caused political embarrassment to President Obama (Pear, 12/30/13).

Reuters: Official who oversaw building of Obamacare website retires Snyder, a career bureaucrat, was identified by U.S. Health and Human Services Secretary Kathleen Sebelius at a hearing in October as the CMS official who decided to have the federal government fulfill the key role of system integrator for HealthCare.gov. But Sebelius also told lawmakers: "Michelle Snyder is not responsible for the debacle. Hold me accountable for the debacle. I'm responsible." ... Snyder has not taken a public role in defending the administration's work on HealthCare.gov or its effort (Cornwell, 12/30/13).

The Wall Street Journal: Republicans Pin Hopes On Midterm Elections
Mr. Obama's fading popularity and the rocky debut of his sweeping health-care law have given Republicans a big jolt of optimism that they can build on their 31-seat House majority and retake the Senate (King, 1/1).

The Washington Post: Obama’s OFA Begins Effort To Showcase Personal Health Care Testimonials
With millions of Americans starting to receive health insurance coverage under the Affordable Care Act on Wednesday, President Obama’s political organization is starting a new campaign to highlight the personal stories of people benefiting under the new law (Rucker, 1/1).

The Washington Post: Medicare Pricing Drives Health-Care Costs
Medicare may be best known for paying the medical bills for millions of people 65 and older, but recent studies show it plays another gargantuan role in American health care: It helps determine prices for everyone. For virtually every procedure and service — from routine colonoscopies to brain surgery and hospice care — Medicare comes up with a dollar figure that the government considers a fair price. But economists are finding that, largely because of the program’s vast scale, Medicare prices substantially shape what all Americans pay for health care (Whoriskey and Keating, 12/31/13).

NPR: 'Good Behavior' More Than A Game To Health Care Plan
Behaving well in elementary school could reduce smoking in later life. At least, that's what Trillium Community Health Plan hopes, and they are putting their money behind it. Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the "Good Behavior Game." Teacher Cami Railey sits at a small table, surrounded by four kids. She's about to teach them the 's' sound and the 'a' sound. But first, as she does every day, she goes over the rules (Foden-Vencil, 1/2).

Los Angeles Times: Oregon Allows Mothers To Take Placentas Home From Hospital
New mothers will now be able to leave Oregon hospitals with two bundles of joy — one in a car seat, the other in a cooler. The first, of course, is the baby. The second, thanks to one of the more curious laws that went into effect with the new year, is the placenta. Many cultures have long revered the meaty organ, whose chief duty is to provide nourishment and oxygen to the fetus. Traditional Cambodian healers call the placenta "the globe of the origin of the soul" and believe it must be buried properly to protect the newborn (La Ganga, 12/31).

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This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.